- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,623.41 / $14,454.40
| Facility | | $1,819.70 | $5,623.41 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,819.70 / $3,890.45
| Professional | | $1,513.56 | $1,819.70 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $13,182.57 / $26,302.68
| Facility | | $4,677.35 | $13,182.57 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,089.30 / $4,168.69
| Professional | | $1,380.38 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $5,011.87 / $17,782.79
| Facility | | $398.11 | $5,011.87 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $5,370.32
| Professional | | $1,621.81 | $2,511.89 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $11,748.98 / $31,622.78
| Facility | | $3,548.13 | $11,748.98 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,041.74 / $3,801.89
| Professional | | $1,445.44 | $2,041.74 | $3,801.89 |